Women's experiences and views about costs of seeking malaria chemoprevention and other antenatal services: a qualitative study from two districts in rural Tanzania

Abstract

BackgroundThe Tanzanian government recommends women who attend antenatal care (ANC) clinics to accept receiving intermittent preventive treatment against malaria during pregnancy (IPTp) and vouchers for insecticide-treated nets (ITNs) at subsidized prices. Little emphasis has been paid to investigate the ability of pregnant women to access and effectively utilize these services.ObjectivesTo describe the experience and perceptions of pregnant women about costs and cost barriers for accessing ANC services with emphasis on IPTp in rural Tanzania.MethodsQualitative data were collected in the districts of Mufindi in Iringa Region and Mkuranga in Coast Region through 1) focus group discussions (FGDs) with pregnant women and mothers to infants and 2) exit-interviews with pregnant women identified at ANC clinics. Data were analyzed manually using qualitative content analysis methodology.FindingsFGD participants and interview respondents identified the following key limiting factors for women's use of ANC services: 1) costs in terms of money and time associated with accessing ANC clinics, 2) the presence of more or less official user-fees for some services within the ANC package, and 3) service providers' application of fines, penalties and blame when failing to adhere to service schedules. Interestingly, the time associated with travelling long distances to ANC clinics and ITN retailers and with waiting for services at clinic-level was a major factor of discouragement in the health seeking behaviour of pregnant women because it seriously affected their domestic responsibilities.ConclusionA variety of resource-related factors were shown to affect the health seeking behaviour of pregnant women in rural Tanzania. Thus, accessibility to ANC services was hampered by direct and indirect costs, travel distances and waiting time. Strengthening of user-fee exemption practices and bringing services closer to the users, for example by promoting community-directed control of selected public health services, including IPTp, are urgently needed measures for increasing equity in health services in Tanzania.

Prevention of Malaria during Pregnancy: Assessing the Effect of the Distribution of IPTp Through the National Policy in Benin

“…16 In Gambia and Tanzania as well, the intake of two SP doses was quite uncommon. 17,18 In Tori Bossito, women are well-followed during their pregnancy, with an average of four ANVs; however, it seems, regarding to anterior studies, that even high rates of attendance to ANVs are not sufficient for a good IPTp coverage and uptake, 14 because the quality of service delivery and the community perceptions and behavior have a great importance as well. 14 Among the factors that need to be improved, one of the main ones is the poor adherence to the official recommendations.…”

Barriers to Antenatal Care in an Urban Community in the Gambia: An In-depth Qualitative Interview Study

“…Previous reports from throughout sub-Saharan Africa have recognized some of these barriers, but a number of these studies have been quantitative surveys. It is interesting to note that when a structured questionnaire 4,11,12,14,15 is used there is more emphasis on the practical barriers to attendance whereas the more open-ended, lessconstrained approach with a qualitative study 5,[6][7][8]10 enables the identification of additional and more complex barriers. During the first three months the barriers are almost entirely identified by qualitative studies.…”

“…Although government supported health centres in the Gambia do not charge, the costs of care in other countries was regularly cited as a difficulty 7,10,11,14 . Also cited were conflicting domestic demands, journey time and distance to the HC 10,4,12 .…”

“…Also cited were conflicting domestic demands, journey time and distance to the HC 10,4,12 . In addition the qualitative studies reported many more instances of poor relationships with the health staff, shame or humiliation if the documentation was not in place 7 , and an overriding suspicion that they were perceived as poor and uneducated 5 .…”

“…Throughout sub-Saharan Africa, in addition to social taboos, there is evidence that women are unsure of the purpose behind antenatal care 7 , probably due to a belief that childbearing represents a normal ‗bodily experience' rather than an illness 8 . Practical barriers to using antenatal care include remoteness from treatment facilities and costs [9][10][11] , a belief that attendance is necessary to obtain a document that permits delivery within the hospital 8 , and the attitude of health professionals [12][13][14][15] . The barriers to antenatal care remain unstudied in an urban context.…”